title: Potentially inappropriate use of psychotropic medications in hospitalized elderly patients in France: cross-sectional analysis of the prospective, multicentre SAFEs cohort.
abstract: BACKGROUND
  In France, there is evidence to suggest that 50% of elderly individuals are prescribed psychotropic medications. However, it is known that use of these agents increases the risk of falls, fractures and delirium in older people.
  
  
  OBJECTIVE
  To study the consumption of 'potentially inappropriate medication' (PIM) among patients aged>or=75 years, paying particular attention to psychotropic drugs and the factors influencing the use of 'potentially inappropriate psychotropics' (PIPs).
  
  
  METHODS
  This was a cross-sectional analysis of a prospective multicentre cohort of 1306 hospitalized French patients aged>or=75 years (the SAFEs [Sujet Agé Fragile: Evaluation et suivi (Frail Elderly Subjects: Evaluation and follow-up)] cohort). The present analysis involved the 1176 patients for whom there was information on the usual treatments being taken in the 2 weeks before hospitalization. The drugs were coded according to the Anatomical Therapeutic Chemical classification; the Beers list as updated in 2003 defined which medications were considered PIPs. Standardized geriatric assessment variables were recorded on inclusion in the study. Logistic regression analysis was performed to identify factors linked to use of psychotropics and PIPs.
  
  
  RESULTS
  The mean number of drugs taken was 5.7+/-2.9 per patient. Twenty-eight percent of patients took at least one PIM. The number of patients who had taken at least one psychotropic drug in the 2 weeks before hospitalization (mean 1.6+/-0.9 psychotropics per patient) was 589 (50.1%). More than half of both the 510 patients with a depressive syndrome and the 543 patients affected by dementia were treated with psychotropics. Multivariate analysis showed that prescription of psychotropics was linked to the presence of a dementia syndrome (odds ratio [OR]=1.4; 95% CI 1.1, 1.9; p=0.03), the presence of a depressive syndrome (OR=1.7; 95% CI 1.3, 2.1; p<0.001), living in an institution (OR=2.2; 95% CI 1.5, 3.4; p<0.001), use of more than five drugs (OR=3.2; 95% CI 2.5, 4.2; p<0.001) and Charlson's co-morbidity score>1 (OR=0.6; 95% CI 0.5, 0.8; p=0.001). Nineteen percent of all psychotropics prescribed were PIPs. Of these PIPs, 66.5% were anxiolytics, 28.4% were antidepressants and 5.1% were antipsychotics. Use of PIPs in the multivariate analysis was associated only with consumption of more than five drugs (OR=1.7; 95% CI 1.1, 2.5; p=0.01).
  
  
  CONCLUSIONS
  PIM use is common among hospitalized older adults in France. The most important determinant of risk of receiving a psychotropic medication or a PIP was the number of drugs being taken. The elderly, who have multiple co-morbidities, complex chronic conditions and are usually receiving polypharmacy, are at increased risk for adverse drug events. These adverse events are often linked to problems that could be preventable such as delirium, depression and falls. Regular review of prescriptions would help optimize prescription of psychotropics in the elderly. The Beers list is a good tool for evaluating PIMs but is too restrictive with respect to psychotropics; in the latter respect, the list could usefully be widened.
authors.affiliation: University of Reims Champagne-Ardenne, Faculty of Medicine, EA 3797, and Department of Clinical Gerontology, University Hospitals of Reims, Reims, France.
authors.forename: Max
authors.initials: M
authors.lastname: Prudent
authors.forename: Moustapha
authors.initials: M
authors.lastname: Dramé
authors.forename: Damien
authors.initials: D
authors.lastname: Jolly
authors.forename: Thierry
authors.initials: T
authors.lastname: Trenque
authors.forename: Renaud
authors.initials: R
authors.lastname: Parjoie
authors.forename: Rachid
authors.initials: R
authors.lastname: Mahmoudi
authors.forename: Pierre-Olivier
authors.initials: PO
authors.lastname: Lang
authors.forename: Dominique
authors.initials: D
authors.lastname: Somme
authors.forename: François
authors.initials: F
authors.lastname: Boyer
authors.forename: Isabelle
authors.initials: I
authors.lastname: Lanièce
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Gauvain
authors.forename: François
authors.initials: F
authors.lastname: Blanchard
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Novella
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged / Q000706:statistics & numerical data*; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003625:Data Collection; D003693:Delirium / Q000150:complications / Q000523:psychology; D003704:Dementia / Q000150:complications / Q000523:psychology; D004347:Drug Interactions; D004363:Drug Utilization; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D005602:France / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D055656:Prescriptions / Q000592:standards*; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012959:Socioeconomic Factors
chemical_list: D011619:Psychotropic Drugs